Meetings of Societies.

/ I. Dr Foulis showed?(1.) a solid sarcomatous tumour of the OVARY, removed lately by Dr Keith from a lady in London. The tumour had been of very slow growth, and was supposed by all who had seen her to be a uterine fibroid. A suspicion of its real nature led Dr Keith to examine microscopically the ascitic fluid which surrounded the tumour in very small quantity. This wa3 found to contain many small masses of proliferating epithelial cells, which Dr Foulis had, on various occasions, already described to the Society. As the tumour had lately grown rapidly, and was evidently killing the patient, Dr Keith advised removal. The operation was one of great difficulty, owing to adhesion to the

in the title, there was no mention of its being only applicable to antiseptic wounds; and lie had therefore come to-night, expecting to hear about a system of drainage applicable to all wounds.Then, in the second place, he rather gathered from Mr Chiene's remarks and the account of the cases, that the use of the catgut was not so much as a drain, but that it promoted the absorption of fluids.
He would further like to know, how much fluid had been effused in the cases?The ankle-joint case was not dressed for four days, and therefore one might ask, what was there to drain?Then the system was inapplicable to suppurating wounds.His remarks on these two points might be wrong, but this was due to the mis- leading nature of the title.But the one case where putrefaction and suppuration occurred showed that the catgut acted as a foreign body in the case of putrid wounds.The subject of catgut in wounds was a new one, and they were indebted to Mr Chiene for working at it.From his experience of antiseptics he did not think it would answer.The amount of catgut used would be expensive; and, besides, the drainage-tube he believed to be better when special drainage was required.Another point he had already referred to was, whether it was possible to promote absorption of the serous effusions by means of the catgut drain, instead of allow- ing it to soak away.
If it turned out that fluid could in this way be absorbed, so that, as Mr Chiene had said, they need not look at a wound until it had healed, then this new system would be most valuable.As yet he was a sceptic; but Mr Chiene, as an inventor, must be prepared to meet with difficulties and opposition.These, however, he believed Mr Chiene's practical talent would overcome in the right way.
Dr John Duncan had great satisfaction in seeing the system of drainage in general recognised as an important addition to surgical armature.In 1863 his friend Dr Steel and himself saw, in Paris, Chassaignac use drainage in everything from caries to whitlow.We were so interested in it that we sent specimens to Mr Syme and Mr Spence.It was not, however, received with the dclat it merited.In his thesis for the Fellowship of the Royal College of Surgeons, he again advocated the system of drainage; and now he was glad to find it so universally believed in.It had, however, been made much more efficient and useful by means of antiseptics.When Mr Chiene said to him a short time ago, that he had been trying this new plan of drainage, it struck him that it w;is an improvement.A drain that was absorbable was better than one that required to be removed, as an indiarubber tube did, because the mechanical manipulation of removal was an irritation in itself; thinking therefore, a priori, that this was an improvement, he tried it in two cases, one of enchondroma of the parotid, the other of fatty tumour in the posterior triangle of the neck.Both operations were conducted antiseptically and with success in their management.
In these he tied the vessels with catgut, and, [AUG.instead of cutting the ends short, brought them out at the line of incision.
He did not know whether this method was Mr Chiene's or his own.In the first case three vessels were tied; in the second, six; and the drain in the former consisted therefore of six threads; in the latter, of twelve.Both healed with almost no discharge.From his using catgut stitches he could really say that his fingers never touched the wound during the time be- tween the operation and the healing.Mr Chiene's catgut drain could thus be used with perfect safety; and as the amount of discharge would depend on the vascularity of the wound, there would be, in the consequent number of ligatures used, an efficient drain.He believed that the catgut drain would prove exceedingly useful.
The President wished to narrate a case like Dr Duncan's, not, however, treated antiseptically, although it would compare favour- ably with any such.In this he did not at all mean to say anything against antiseptics.The patient was a boy, with a bunch of enlarged glands under the jaw, extending from the angle to the symphysis.They had been there for several months, and were disfiguring him very much.He accordingly removed them exactly a week ago by an incision, three inches long, below the angle of the jaw.One moderately large vessel required to be tied, and some other small ones he twisted.He tied the vessel with some chromicacid catgut Mr Chiene had given him, and stitched up the wound with the same.
As the vessel so tied was near the surface, he brought the two ends of the ligature out at the end of the incision.He had removed the stitches, but the ligature was still in the wound, feeling as hard as iron wire, and likely to remain there, Mr Chiene informed him, for three weeks.The boy was quite well and playing about, the wound having healed by first intention.The glands, when cut into, though chiefly solid, were found to contain small deposits of pus, and it was therefore better to excise them than have troublesome long-continued suppuration.Thus, without antiseptics, and using chromic-acid catgut, he had got a most satis- factory result.
If it soaked up the fluids, they were still there; and if not, they must still drain away.He was glad Mr Annandale had objected, as further experiments would be made.If they succeeded, well and good ; but if not, then the catgut drain must go into the background, like a great many other things, and something else come in its place.
III. Dr Hunter then read a paper on PUERPERAL FEVER AND septicemia, their relation and probable identity, with cases, which will appear in a future number.
The President felt sure the Society was indebted to Dr Hunter for his interesting paper.
Professor Simpson thought the Society, and indeed the whole profession, were indebted to Dr Hunter for his valuable paper.It certainly required a great deal of courage to bring forward the series of disastrous cases so admirably detailed.The question now was, were we to retain the term puerperal fever as distinctive of a single variety out of the pretty extensive group of fevers in women, which were all puerperal, because they occurred in the puerperal state.
Thus, typhoid fever or smallpox or any of the zymotic fevers might lay hold of a puerperal woman, and, owing to her peculiar condition, the fever in her was apt to become very intense, and at times so rapidly fatal that there was no time for the mani- festation of characteristic eruptions.This was more particularly the case in women who had never before been exposed to their infection, to whom even the mildest of the zymotic fevers was likely to be deadly.In one case, of a lady who had been sedulously guarded from infantile diseases, an attack of measles in her thirteenth con- finement proved fatal in a few days.Again, the erysipelatous poison coming in contact with the vaginal or other canals of a parturient female, caused symptoms similar to those arising after a surgical operation in a patient exposed whilst the wound was fresh to the same poison.Then there was the group of cases so well brought forward by Dr Hunter, where the surgeon got impregnated with a poison, which would give a surgical patient a fever, with local manifestations, from the introduction of poison into a wound.This, as taught by the late Sir James Simpson, should be held as puerperal fever when the patient was a puerperal woman.There were two things which would have added to the value of Dr Hunter's communication, but which could not resonably have been required from him, viz., a post-mortem examination of thi woman who had died, and also of the fatal surgical case.This would, no doubt, have shown lymphatic inflammation, thrombosis, and metastatic inflammations.
He had collected in the dissecting-rooms at Vienna, the results of post-mortems of patients dying after puerperal fever and after surgical operations.The results in both classes of cases were str kingly similar, especially when the surgical operation had been on [AUG.the abdomen.It would have been interesting further to have' known the health of the puerperal women in the district, at the time of Dr Hunter's fatal cases, as it would have added to the value of his paper.He had undoubtedly carried a morbific agent, and it was therefore important to watch the kind of source from which such an agent might arise, and it might come from less striking sources than the case to which Dr Hunter had traced his empoisonment.Thus, in a case of his own, it was traced to the sore thumb of the nurse 5 and in a second instance, it was also traced to the nurse, who had been dressing an old ulcer on her leg.Then, again, the obstetrician might get the poison from the fetid lochial discharge of a patient already confined, although it was doing the woman herself no harm, for the simple but very sufficient reason that ere the discharge had become dangerous, the lacerations in her own genital canals had begun to granulate, or that there had been no wound surface produced during her labour.
Such injuries were far more likely to be found in primiparse than in multipara?, and in this connection it Avas interesting to observe that in the series of cases where Dr Hunter attended women in labour who escaped, the table showed these to be all multiparous, and the first in wliom the mischief again began was a primipara.
He felt much interested in Dr Hunter's cases, and was sure they all felt grateful to him for his very able communication.
Dr A. Macdonald wished simply to endorse Professor Simpson's remarks.The contribution was valuable, and one much needed in science.There was always a certain amount of reluctance in furnishing such cases; and although the practitioner was honoured by his brethren, yet the popular amount of credit was not in pro- portion to his deserts.No member would now deny the view of puerperal fever advocated this evening.The only question was the bearing of antiseptic measures on these cases; whether, by the diligent use of antiseptic agents, such organic fever-poisons could be destroyed.He would fain believe such was the case.It might be true, as Dr Hunter had said, that the hand epidermis might be so impregnated?thatso much poison might lurk in its deeper layers as to cause puerperal septicajmia, even after a three weeks' holiday 011 the part of the medical attendant.He did not, however, think that their present knowledge warranted this.
Probably if the cases were examined, some hidden relationship between them and other causes might be traced, different from what Dr Hunter had shown.Then they knew that carbolic acid caused desquamation of the cuticle ; and most of them would demur to the case of pyaemia where the pulmonary mucous membrane was supposed to be the absorbing medium.It was more probably a scratch in some accessible part.
These were the doubts that occurred to him ; and if it were true that these poisonous influences, bacteria, etc., were so subtle that 110 carbolic acid could kill them, then no obstetrician nor surgeon could, after a stinking wound, go 1876.]MEDICO-CHIRURGIOAL SOCIETY OF EDINBURGH.

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to cases for weeks.Dr Hunter certainly deserved thanks for his interesting paper.
Dr Smart thought that not too much could be said on this im- portant subject.The paper came up opportunely, as the deferred discussion in the London Obstetrical Society gave them the start and lead in the matter.
He was interested and pleased in the paper and remarks, on account of the unanimity which had pre- vailed, and lie hoped the professional minds would be educated in this matter.Dr Hunter was not limited to the pulmonary mucous membrane for the absorption of poisons, as the eye is often a habitat for such.Then as to Dr Hunter's doubts on the source of the poison, he should remember that puerperal women are so susceptible, that an infinitesimal dose might do all the mischief.Many years ago, in a debate at the Royal Medical Society, he had ventured to generalize the whole question into one of septicaemia.
As physician and pathologist in one of the largest obstetrical hospitals in Britain, he had ample proof that puerperal fever was septicremia.He indeed considered it dangerous for an accoucheur or medical man in practice to attend at a post-mortem.As to the question of puerperal fever existing as an epidemic, if they admitted it was a septic disease, then they got at the question at once.
There was no epidemic of puerperal fever apart from direct septic influences.All knew how easy it was to produce an epidemic or quasi-epidemic.Medical men should therefore be very careful in avoiding all places where such danger could be.
Dr Hunter did not, at such a late hour, wish to enter into any detailed reply.He thanked the members for their favourable and lenient criticism.In regard to what Professor Simpson suggested about post-mortem examinations of the fatal cases, lie thought the Society would agree with him that he would not have been justified in making them.Indeed, when lately called on by the Procurator- Fiscal to make such an examination, he had declined doing so.He was glad to hear Dr Macdonald's remarks, and only regretted that time prevented him replying more fully.
OBSTETRICAL SOCIETY OF EDINBURGH.SESSION XXXV.?MEETING X.
Wednesday, 10th May.?Professor Simpson, President, in the Chair.J I. Professor Simpson exhibited a partially dimidiate placenta, S\f and stated that, though in this case he had not had an opportunity of ascertaining the seat of insertion, in two others with which he had met, he had found that one portion of the placenta was adherent to the anterior, and the other to the posterior wall of the uterus, while the membranous portion between corresponded to the angle betwixt the two walls of the organ.It was well known that the uterine mucosa was much thinner along this angle than on the anterior and posterior walls; and it might be [AUG.
that, in cases where a dimidiate placenta was ultimately developed, the vascularized portion of the chorionic villi corresponded to one of the sides of the uterus, and got embedded partly on the anterior and partly on the posterior wall.The preparation had, further, a pathological interest, from the circumstance that the patient had suffered from slight haemorrhage and watery discharge about the middle of pregnancy.
Between the sixth and seventh month, symptoms of labour set in, with a watery discharge, which the patient, a multipara, supposed to be the liquor amnii, though the membranes were unbroken ; and, after some hours, the foetus was ex- pelled alive, but survived only half an hour.On examination of the secundines, there was seen an old decolorized clot adherent to the uterine surface of the decidua, where probably a ruptured vessel had furnished the discharge during gestation; and, at the margin of the placenta, was found a more recent clot, the serum of which had probably furnished the watery discharge noticed at the com- mencement of the labour.II.Br James Young read a paper entitled, " remarks ON VACHEU's FORCEPS, A NEW AND IMPROVED FORM."The principal feature being the elongation of the stem, giving more space in the adaptation of the blades over the foetal head, the shaft being four inches and a half in length, while in the forceps of Dr Vaclier the shaft is only one inch and a half.
Professor Simpson remarked that, being accustomed to the old form of forceps, we were naturally unwilling to adopt new ones.He could not see that this forceps, either in its original form or that as modified by Dr Young, had any advantage over the others in general use.
Dr Bruce failed to see in what respect they could be preferred over the ordinary form of short forceps.Br Macdonald considered that this forceps was constructed in such a way as to prevent the blades adapting themselves properly to any size of bevel.
Br Young, in reply, stated he merely showed these forceps as he considered them an improvement on Vaclier's original form.He must allow that they were still open to many objections.
III. Br Macdonald concluded his paper on puerperal ECLAMPSIA.
Professor Simpson thanked Dr Macdonald for continuing his paper and rendering it complete by reference to treatment.He thought Dr Macdonald's principles of treatment judicious.Each case, how- ever, ought to be dealt with on its own merits.
Br James Young personally thanked Dr Macdonald for his paper, more especially for his having gone so fully into the treatment.In his experience he had several times used the lancet?inone case, he believed, with the result of saving the patient's life.In another case in which venesection had been performed, the patient died.As a rule, he rested his whole strength on hydrate of chloral, 1870.]OBSTETRICAL SOCIETY OF EDINBURGH.177 find most of the cases treated by this medicine had made good recoveries.He had used chloroform, but regarded it only as a palliative.
Dr Cappie said that, in speaking of treatment, Dr Macdonald had not referred to a class of cases in which convulsions and coma occurred before labour had commenced.A few years ago, he had read a paper to the Society detailing three such cases, and since then, four more had occurred in his practice.These were all first pregnancies, where the seizures came on before the full period of gestation, where they recurred every twenty or thirty minutes, and where, in a short time, the patients became so completely insensible that it was impossible to interfere with drugs.He had treated these cases as he had done those previously published.After waiting a few hours to ascertain whether the fits might not show a tendency to subside spontaneously, he adopted means to empty the uterus.As far as possible, he dilated the os uteri with at first one finger, then two, then three fingers.After the os could admit three fingers easily, he had been able to apply his forceps, and to finish the labour in the manner he had previously detailed to the Society.The results were as follows : In the first case, the labour was terminated in about two hours after beginning to dilate the os.The child was living, and the mother made such a good recovery, that she was able to nurse the child, and has been a second time confined without any complication occurring.The second case was more difficult, and the result was unfortunate.
The child (dead) was delivered within a moderate time, but the fits continued frequent and strong, and the patient sank from ex- haustion.The third case was one of Bright's disease of the kidneys, where there was great nervous depression on account of the patient at one time having been told by a physician that it would be an unfortunate thing for her if she should ever fall in the family way.The child was born alive, but died shortly afterwards from the debility of premature birth.The patient made a good recovery, had a second pregnancy, which ended by^ miscarriage, and some months afterwards she died from paralysis and other complications of Bright's disease.In the fourth case, the child was also born alive, but died a few days afterwards from debility.
The mother made an excellent recovery.The urine in this case was so albuminous, that, on being heated, it became so solid that the test tube could be inverted without a single drop of fluid escaping.This patient is at present at the end of the eighth month of her second pregnancy, and as yet no albuminuria has shown itself.
Dr Dickson asked Dr Matthews Duncan what warning symptoms were observed in cases without albuminuria.
Dr James Carmichael thought every case ot convulsion should be dealt with on its own merits.He would refer to one case in which he believed the patient's life had been saved by bleeding. [AUG.
In this case the convulsions were almost continuous, so that the respiration and heart's action, as well as the function of the brain, were becoming seriously interfered with.The os uteri would scarcely admit the linger, was hard and rigid.Bleeding to the extent of nearly 30 ounces was resorted to, with the most beneficial effects.The severity of the fits was much abated, there being now an intermission between them.The os became flaccid, and within half an hour was so far dilated by natural and artificial means as to allow of the child being delivered by turning.The baby survived.
Dr Murray also mentioned a case in which convulsions had lasted for several days, and various plans of medical treatment had been adopted without effect.In this case bleeding was resorted to with good results.Dr Macdonald briefly thanked the Fellows for the cordial recep- tion given to his paper.
IV. Dr Matthews Duncan then read a paper by Dr Macdougall of Carlisle on a case of extra-uterine fcetation treated by ab- dominal section, which appeared at page 11 of the Journal for July.
On the proposal of the President, the discussion of this paper was deferred till next meeting.